Billing code 92601: Cochlear implantMedicare rate & RVUs in Florida
Report cochlear implant diagnostic analysis with programming for a child younger than 7 when the audiologist evaluates implant function and adjusts processor settings.
Medicare pays $151.09–$157.99 for 92601 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 92601 covers
An audiologist uses this service to evaluate a cochlear implant and program the sound processor for a child younger than 7. The visit may include checking device function, assessing the child’s auditory responses, and adjusting the processor program, or map, based on the evaluation. It is used for pediatric cochlear implant management when diagnostic analysis and programming are performed, rather than for a programming-only visit.
Choose the code based on the patient’s age and the service performed: 92601 is for diagnostic analysis with programming under age 7; 92602 is for subsequent reprogramming in that age group. The record should support the diagnostic work and programming performed, including relevant findings and adjustments. CMS classifies this as a therapy service, so the professional component modifier 26 is not used.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 92601 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$151.09 to $157.99
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $155.59 | $98.74 |
| Miami | $157.99 | $99.57 |
| Rest Of Florida | $151.09 | $97.44 |
How the 92601 rate is calculated
Each of 92601’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 92601
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.30Practice expense 2.31Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 92601
The CMS indicators that decide how 92601 is paid alongside other services.
CMS payment indicators · 92601
Cochlear implant
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
92601 without CQ · national office
$154.31
Cochlear implant
92601-CQ · Allowed amount unchanged
$154.31
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
92601 compared with similar codes
Compare codes
92601 vs 92602 vs 92603 vs 92604: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 92602Implant reprogramming
- Use 92601 for diagnostic analysis with programming in a child younger than 7; use 92602 for subsequent reprogramming in that age group.
- 92603Implant analysis
- The service is diagnostic analysis with programming in both codes. The patient is younger than 7 for 92601 and age 7 or older for 92603.
- 92604Cochlear implant programming
- 92604 describes subsequent reprogramming for a patient age 7 or older; 92601 is diagnostic analysis with programming for a child younger than 7.
92601 billing questions
When should 92601 be selected instead of 92602?
Use 92601 when the encounter includes diagnostic analysis of the cochlear implant with programming for a child younger than 7. Use 92602 for subsequent reprogramming without that diagnostic analysis service.
How does 92601 differ from 92603?
Both describe diagnostic analysis with programming, but 92601 is for a patient younger than 7 and 92603 is for a patient age 7 or older.
Can modifier 26 be appended to 92601?
No. CMS classifies 92601 as a therapy service, for which the professional component modifier does not apply.
What documentation supports reporting 92601?
Document the cochlear implant assessment, relevant device or auditory findings, and the programming performed. The record should support diagnostic analysis, not programming alone.
Is 92601 a time-based code?
The code is distinguished by the diagnostic analysis and programming service and the patient’s age, not by a time increment in its descriptor.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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